Chapter 23-male reproductive system PDF

Preview

Summary

male reproductive system assessment...

Description

Ch. 23 Male Reproductive System: ● External: ○ Penis and Scrotum ● Internal: ○ Tests, spermatic cord, duct system, accessory glands, inguinal and perineal areas ● Scrotum: houses the tests, which produce sperm ○ Maintains a core temp of approximately 3 degrees C cooler than core body temp ○ Left Spermatic Cord is longer than the right ○ Cremaster and dartos muscles ○ Protects the tests, epididymides, spermatic cord and spermatogenesis ● Testes: produce spermatozoa and secrete testosterone ○ Two firm, rubbery olive shaped structures that manufacture sperm ○ Outer tunica vaginalis and inner tunica albuginea ○ Testicular veins from pampiniform plexus ● Spermatic Cord: fibrous connective tissue ○ Forms a protective sheath around the nerves, blood vessels, lymphatic structures and muscle fibers associated with the scrotum ● Duct System ○ Epididymis: coiled tube that forms the beginning of the male duct system ; forceful contraction propels the sperm into ductus deferens ○ Ductus Deferens: mature sperm remain here until ready for transport ○ Urethra: conduit for both urine and semen to move out of the body ● Accessory Glands: ○ Seminal Vesicles: sources of 60% of semen; secreted into ejaculatory duct where seme nourishes and dilutes sperm to enhance motility ○ Prostate Gland: glandular structures that continuously secrete a milky, alkaline solution that aids in sperm transport ○ Bulbourethral Gland: located below prostate within urethral sphincter; secrete clear mucus just before ejaculation to increase alkaline environment ● Penis: ○ Shaft consists of 2 dorsolateral column (corpora cavernosa) and midventral column surrounding urethra ○ Contracts and elongates during sexual arousal, allowing it to deposit sperm into the female vagina ○ Foreskin in uncircumcised men

● Inguinal Areas: ○ Inguinal ligaments ○ Inguinal canal: associated with abdominal muscles ○ Inguinal Hernia: weak points of inguinal canals can afford protrusion of the intestine into the groin region ■ Direct Hernia: extrusion of abdominal intestine into inguinal ring; bulging occurs in the area around the pubis; abdominal intestine remain within the inguinal canal or extrude pass the external ring ● S/S: painless, swelling, have patient cough during palpitation you will feel pressure against the side of your finger ■ Indirect Hernia: abdominal intestine remain within the inguinal canal or extrude past the external ring; most common type; located within the femoral canal ● S/S: swelling, have the patient cough during palpitation you will feel pressure against your fingertips; palpate soft mass ■ Femoral Hernia: bulge occurs over the area of the femoral artery; the right femoral artery is affected more frequently than the left; lowest incidence of all three hernia ● S/S: may not be painful; however once strangulation occurs pain is severe ● Perianal Area: ○ Anal Canal: opens onto perineum at midpoint of gluteal folds; external muscles are skeletal ○ Rectum: prostate gland in close proximity to anterior surface ○ Perineum: smooth surface free of lesions ● Healthy People 2020: ○ Reduce the incidence and prevalence of STDs; increase screening and preventive measures ○ Decrease the transmission rate of HIV ○ Prevent the development of AIDS ○ Reduce HIV related deaths ● Lifespan Considerations: ○ Infants and Children: ■ Should be unambiguous ■ Variation in urethral openings such as hypospadias and epispadias ■ Phimosis ■ Proportion of infant’s scrotum to penis ■ Puberty occurs between 10-15 years of age ■ Assess for sexual molestation

■ Adolescents are interested in exploration of sexual contact and relationships ○ Older Adults: ■ Enlargement of the prostate gland ■ Decrease in the size of the penis and testes ■ Decrease testosterone production in aging in decreased libido and sexual response ● Psychosocial Considerations: ○ Fatigue, depression, and stress can decrease sexual desire at any age ○ Sexual relationships are affected by the patient’s history, especially if trauma or abuse occurred ○ Male body image may be affected by penis size ●

Cultural and Environment Consideration: ○ Culture and Religions: Circumcision ○ Race and Ethnicity: prostate cancer ○ Overcrowded living conditions ○ Sexual orientation ○ Microelectronics industry

● Assessment Techniques: ○ Inspect the pubic hair, penis, scrotum, and inguinal area, perianal area, anus ○ Palpation of the penis scrotum, testes, and epididymis, spermatic cord, inguinal region, inguinal lymph chain, sacrococcygeal and perianal area, bulbourethral and prostate glands ○ Stool testing for occult blood ● Abnormal Finding: ○ Inguinal Hernias (direct, indirect, femoral) ○ Abnormalities of the penis, scrotum, and perianal area ● Abnormalities of the Penis: ○ Hypospadias: ■ The congenital displacement of the meatus to the inferior surface of the penis, most commonly near the tip of the penis, the opening may also appear in the midline or base of the penis, or behind the scrotum ○ Peyronie’s Disease: ■ Hard plaques are found along the dorsum and are palpable under the skin that result in pain and bending of the penis during erection ○ Carcinoma:

■

usually occurs in the glans, it appears as a reddened nodule growth, or ulcer like lesion ○ Genital Warts: ■ a sexually transmitted disease by human papillomavirus (HPV) genital warts are rapidly growing papular lesions ○ Syphilitic Chancre: ■ these nontender lesions appear as round or oval reddened ulcers. A chancre often is the first symptom of primary syphilis, a sexually transmitted disease, lymphadenopathy is present ○ Genital Herpes: ■ a sexually transmitted disease caused by the herpes simplex virus, (HSV) these painful small vesicles appear in clusters on any part of the surface of the penis, the area around the vesicles is erythematous ● Abnormalities of the Scrotum: ○ Hydrocele: ■ Fluid filled nontender mass the occurs within the tunica vaginalis ○ Scrotal Hernia: ■ An indirect inguinal hernia located within the scrotum ○ Testicular Tumor: ■ A painless nodule on the testes, as it grows the entire testes seems to be overtaken ○ Orchitis: ■ This inflammatory process results in painful, tender, and swollen testes ○ Epididymitis: ■ The epididymis is inflamed and tender, this condition which can occur in adult males of any age, is most commonly caused by a bacterial infection ○ Torsion of the Spermatic Cord: ■ Torsion occurs with the greatest frequency in adolescence, the twisting of the testicles or the spermatic cord creates edema and pain, requiring immediate surgical intervention ○ Small Testes: ■ Testes are considered small when they are less than 2cm (0.78in) long, atrophy may occur in liver disease, in orchitis, and with estrogen administration ○ Cryptorchidism: ■ Absence of a testicle in the scrotal sac, this condition may result from an undescended testicle ○ Scrotal Edema: ■ Edema of the scrotum is seen in conditions causing edema of the lower body, including renal disease and heart failure. May or may not be painful

occur in males of any age. May be unilateral or bilateral. The testicles and penis also may be edematous, through this is not always the case. Causes include conditions that produce edema of the lower body, uch as renal disease and heart failure. Localized conditions also can cause scrotal edema for example, epididymis, testicular cancer, torsion, and hydrocele ● Abnormalities of the Perianal Area: ○ Pilonidal Cyst: ■ Seen as dimpling in the sacrococcygeal area at the midline. An opening is visible and may reveal a tuft of hair. Usually asymptomatic, these cysts may become acutely abscessed or drain chronically ○ Anal Fissure: ■ Tears or splits in the snal mucosa that are usually seen in the posterior anal area and most frequently associated with the passage of hard stools or prolonged diarrhea. Thar are most common in young infants ○ Hemorrhoid (internal): ■ Varicosities of the hemorrhoidal veins of the anus or lower rectum, internally they occur in the venous plexus superior to the mucocutaneous junction of the anus and are rarely painful. Identified by bright red bleeding that is unmixed with stool. ○ Hemorrhoids (External): ■ Externally, they occur in the inferior venous plexus to the mucocutaneous junction. Rarely bleed, cause anal irritation and create difficulty with cleaning the area ○ Perianal Perirectal Abscess: ■ Painful and tender abscesses with perianal erythema; generally caused by infection of an anal gland, can lead to fistulas (opening between the anal canal and outside skin) ○ Prolapse of the Rectum: ■ Occurs when the rectal mucosa, with or without the muscle, protrudes through the anus. In mucosal prolapse, a round or oval pink protrusion is seen outside the anus, when the muscular wall is involved a large red protrusion is visible...